MEDICARE: MRS. GINA MARIE NELSON LPC, ICGC-I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701008819	VA

General Provider Information

NPI Number	:	1932738994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA MARIE NELSON LPC, ICGC-I

Provider Business Mailing Address
First Line	:	8500 MAYLAND DR STE 2
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4700
Country	:	US
Telephone Number	:	804-505-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 MAYLAND DR STE 2
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4700
Country	:	US
Telephone Number	:	804-505-0062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/10/2023

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